External Rotation Ankle Injuries: Investigating Ligamentous Rupture

2009 ◽  
Author(s):  
Mark R. Villwock ◽  
Eric G. Meyer ◽  
John W. Powell ◽  
Roger C. Haut
Keyword(s):  
High Frequency ◽  
Failure Load ◽  
Sports Injuries ◽  
External Rotation ◽  
Experimental Studies ◽  
Soft Tissue Injuries ◽  
Ankle Injuries ◽  
Ankle Sprains ◽  
Severity Of Injury ◽  
Ankle Complex

Ankle sprains are one of the most common sports injuries [1], accounting for 10% to 15% of these injuries [2]. The severity of injury varies greatly and the player’s recovery time is related to the structures involved and their degree of damage. In contrast to the soft tissue injuries reported in many clinical studies on the ankle, experimental studies have typically generated a high frequency of bone fracture when the foot/ankle complex is externally rotated [3–5]. In a majority of these manuscripts, the cadaveric test specimens are of advanced or unknown age. These variables may substantially affect both the failure load and the mode of failure in the joint, since most ankle sprains occur in people under the age of 35 years [6].

The Snowboarder's Foot and Ankle

1998 ◽  
Vol 26 (2) ◽  
pp. 271-277 ◽  
Author(s):  
Douglas P. Kirkpatrick ◽  
Robert E. Hunter ◽  
Peter C. Janes ◽  
Jackie Mastrangelo ◽  
Richard A. Nicholas
Keyword(s):  
Injury Rate ◽  
Soft Tissue Injuries ◽  
Fracture Pattern ◽  
Ankle Injuries ◽  
Anterior Talofibular Ligament ◽  
Ankle Sprains ◽  
Foot And Ankle ◽  
Foot Injuries ◽  
Lateral Process ◽  
Ski Resorts

We undertook a prospective study to determine the type and distribution of foot and ankle snowboarding injuries. Reports of 3213 snowboarding injuries were collected from 12 Colorado ski resorts between 1988 and 1995. Of these, 491 (15.3%) were ankle injuries and 58 (1.8%) were foot injuries. Ankle injuries included 216 (44%) fractures and 255 (52%) sprains. Thirty-three (57%) of the foot injuries were fractures and 16 (28%) were sprains. The remaining injuries were soft tissue injuries, contusions, or abrasions. There was no significant correlation between boot type (soft, hybrid, or hard) and overall foot or ankle injury rate. There were significantly fewer ankle sprains in patients wearing hybrid boots and fewer fractures of the lateral process of the talus in patients wearing soft boots. An unexpectedly high number of fractures of the lateral process of the talus were noted. These 74 fractures represented 2.3% of all snowboarding injuries, 15% of all ankle injuries, and 34% of the ankle fractures. Many of these fractures are not visible on plain radiographs and require computed tomography imaging to be diagnosed. Diagnosis of this fracture pattern is paramount; the physician should be very suspicious of anterolateral ankle pain in the snowboarder, where subtle fractures that may require surgical intervention can be confused with anterior talofibular ligament sprains.

scholarly journals Characterization of Ankle Kinematics and Constraint Following Ligament Rupture in a Cadaveric Model

2019 ◽  
Vol 141 (11) ◽  
Author(s):  
Bardiya Akhbari ◽  
Matthew H. Dickinson ◽  
Ednah G. Louie ◽  
Sami Shalhoub ◽  
Lorin P. Maletsky
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Training Data ◽  
Ankle Injuries ◽  
Ankle Sprains ◽  
Ligament Rupture ◽  
Ankle Kinematics ◽  
Posterior Translation ◽  
Ankle Mobility ◽  
And Inversion

Ankle sprains are a common injury that may need reconstruction and extensive physical therapy. The purpose of this study was to provide a description of the biomechanics of the ankle joint complex (AJC) after anterior talofibular (ATFL) and calcaneofibular (CFL) ligament rupture to better understand severe ankle injuries. The envelope of motion of ten cadaveric ankles was examined by manual manipulations that served as training data for a radial basis function used to interpolate ankle mobility at flexion angles under load and torque combinations. Moreover, ankle kinematics were examined, while tendons were loaded to identify how their performance is altered by ligament rupture. The increased force required to plantarflex the ankle following ligament rupture was measured by calculating the load through the Achilles. Following ATFL injury, the largest changes were internal rotation (5 deg) in deep plantarflexion and anterior translation (1.5 mm) in early plantarflexion. The combined ATFL and CFL rupture changed the internal/external rotation (3 deg), anterior/posterior translation (1 mm), and inversion (5 deg) throughout flexion relative to the isolated ATFL rupture. Moreover, the Achilles' load increased by 24% after the rupture of ligaments indicating a reduction in its efficiency. This study suggests that if patients demonstrate primarily an increased laxity in internal rotation, the damage has solely occurred to the ATFL; however, if the constraint is reduced across multiple motions, there is likely damage to both ligaments. Higher loads in the Achilles suggest that it is overloaded after the injury; hence, targeting the calf muscles in rehabilitation exercises may reduce patients' pain.

scholarly journals Ultasound guided management of ankle sprain

2018 ◽  
Vol 4 (4) ◽  
pp. 591
Author(s):  
Mattam Sanjay ◽  
Babulreddy Bommireddy ◽  
Matapathi Umamahesh
Keyword(s):  
Ankle Sprain ◽  
High Frequency ◽  
Sports Injuries ◽  
Leisure Activities ◽  
Ankle Sprains ◽  
High Frequency Ultrasound ◽  
Diagnostic Modality ◽  
Residual Symptoms ◽  
One Year ◽  
Frequency Ultrasound

<p class="abstract"><strong>Background:</strong> Ankle<strong> </strong>sprain accounts for 15-20% of sports injuries. They are complex injuries and studies that better delineate the etiology are needed. The accuracy of ultrasound as a diagnostic modality of ankle sprain is comparable to MRI.<sup>  </sup>In this study we evaluated the use of ultrasound in delineating the grade of sprain, with special emphasis of grade 2 sprains.</p><p class="abstract"><strong>Methods:</strong> We prospectively studied 80 ankle sprains of over two years. All the patients with features of ankle sprain were evaluated with high frequency ultrasound. Grade 1 &amp; 2 sprains were included in the study. All the patients were followed up for 1 year. Grade 2 sprains were treated with cast for 6 weeks and evaluated for any residual symptoms and chronicity.<strong></strong></p><p class="abstract"><strong>Results:</strong> There were 51 males and 29 females with right ankle injured in 57 patients. Seventy-three patients were injured during their leisure activities and 7 were sports injuries. According to ultrasound grading, there were 58 grade 1 injuries, 22 being grade 2 sprain. All the patients were followed up till 1 year. At the end of one year, 79 patients were recovered well with no residual symptoms.</p><p class="abstract"><strong>Conclusions:</strong> Ultrasonogram effectively differentiates grade 1 from grade 2 and gives a clue for further management. Therefore, we recommend routine use of ultrasonogram for every ankle sprain. For grade 2 sprains, rigid immobilization for 6 weeks gives excellent results with no residual symptoms.</p>

Determination of In Vivo Dynamic Human Ankle Stiffness Under External Foot Rotation

2012 ◽  
Author(s):  
Keith D. Button ◽  
Jerrod E. Braman ◽  
Feng Wei ◽  
Roger C. Haut
Keyword(s):  
Injury Risk ◽  
Sports Injuries ◽  
External Rotation ◽  
Surface Interactions ◽  
Ankle Sprains ◽  
Ankle Stiffness ◽  
Human Ankle ◽  
Using Data

Ankle sprains account for 10–15% of all sports injuries [1]. Understanding the conditions that contribute to sports-related ankle sprains can provide useful information to footwear designers to help prevent such injuries. Attempts have been made to create surrogate ankles that mimic ankle properties in order to simulate injury scenarios. In this laboratory, using data from cadaver experiments, Villwock et al. developed such an ankle to assess injury risk due to shoe-surface interface [2]. While this model provides data on shoe-surface interactions, it only takes into account ankle stiffness in rotation. Consequently, the model can only recreate internal-external rotation, not eversion-inversion or plantarflexion-dorsiflexion responses of the human ankle.

Effect of Shoe Stiffness on Injury Produced Under External Rotation of the Foot in Human Cadavers

2013 ◽  
Author(s):  
Keith D. Button ◽  
Mark A. Davison ◽  
Jerrod E. Braman ◽  
Maureen C. Schaefer ◽  
Roger C. Haut
Keyword(s):  
Ankle Sprain ◽  
External Rotation ◽  
Ankle Injuries ◽  
Upper Body ◽  
Deltoid Ligament ◽  
Ankle Sprains ◽  
Interosseous Ligament ◽  
Lateral Ankle ◽  
Human Cadavers ◽  
Anterior Deltoid

Ankle sprain is a common occurrence in sports, accounting for 10–30% of injuries 9. Injury to the lateral ligamentous complex occurs under excessive foot inversion and is known as a “lateral ankle sprain” 1. Injury to the anterior deltoid ligament (ADL), which consists of the tibionavicular ligament (TiNL) and the anterior tibiotalar ligament (ATiTL), is known as a “medial ankle sprain” 13. High ankle sprains occur in the distal tibiofibular syndesmosis, which is comprised of the anterior and posterior tibiofibular ligaments (ATiFL and PTiFL) and the interosseous ligament (IOL) 2. While approximately 85% of ankle sprains are lateral ankle injuries, syndesmotic (high) and medial injuries typically result in more time off the field. The mechanism of both high and medial ankle sprain is commonly ascribed to excessive internal rotation of the upper body, while the foot is planted on the playing surface.

Specimen-Specific Computational Models of Ankle Sprains Produced in a Laboratory Setting

2013 ◽  
Vol 135 (4) ◽  
Author(s):  
Keith D. Button ◽  
Feng Wei ◽  
Eric G. Meyer ◽  
Roger C. Haut
Keyword(s):  
Computational Models ◽  
External Rotation ◽  
Experimental Studies ◽  
Cadaver Study ◽  
Deltoid Ligament ◽  
Ankle Sprains ◽  
Tibiofibular Ligament ◽  
Maximum Angle ◽  
Injury Mechanisms ◽  
Ligament Strain

The use of computational modeling to predict injury mechanisms and severity has recently been investigated, but few models report failure level ligament strains. The hypothesis of the study was that models built off neutral ankle experimental studies would generate the highest ligament strain at failure in the anterior deltoid ligament, comprised of the anterior tibiotalar ligament (ATiTL) and tibionavicular ligament (TiNL). For models built off everted ankle experimental studies the highest strain at failure would be developed in the anterior tibiofibular ligament (ATiFL). An additional objective of the study was to show that in these computational models ligament strain would be lower when modeling a partial versus complete ligament rupture experiment. To simulate a prior cadaver study in which six pairs of cadaver ankles underwent external rotation until gross failure, six specimen-specific models were built based on computed tomography (CT) scans from each specimen. The models were initially positioned with 20 deg dorsiflexion and either everted 20 deg or maintained at neutral to simulate the cadaver experiments. Then each model underwent dynamic external rotation up to the maximum angle at failure in the experiments, at which point the peak strains in the ligaments were calculated. Neutral ankle models predicted the average of highest strain in the ATiTL (29.1 ± 5.3%), correlating with the medial ankle sprains in the neutral cadaver experiments. Everted ankle models predicted the average of highest strain in the ATiFL (31.2 ± 4.3%) correlating with the high ankle sprains documented in everted experiments. Strains predicted for ligaments that suffered gross injuries were significantly higher than the strains in ligaments suffering only a partial tear. The correlation between strain and ligament damage demonstrates the potential for modeling to provide important information for the study of injury mechanisms and for aiding in treatment procedure.

scholarly journals Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

2011 ◽  
Vol 4 (1) ◽  
pp. 5 ◽  
Author(s):  
Hans Polzer ◽  
Karl Georg Kanz ◽  
Wolf Christian Prall ◽  
Florian Haasters ◽  
Ben Ockert ◽  
...  
Keyword(s):  
External Rotation ◽  
Clinical Importance ◽  
Complex Iii ◽  
Ankle Injuries ◽  
Diagnosis And Treatment ◽  
Lateral Ligament ◽  
Evidence Based ◽  
Ankle Sprains ◽  
Level Of Evidence ◽  
Residual Symptoms

Acute ankle injuries are among the most common injuries in emergency departments. However, there are still no standardized examination procedures or evidence-based treatment. Therefore, the aim of this study was to systematically search the current literature, classify the evidence, and develop an algorithm for the diagnosis and treatment of acute ankle injuries. We systematically searched PubMed and the Cochrane Database for randomized controlled trials, meta-analyses, systematic reviews or, if applicable, observational studies and classified them according to their level of evidence. According to the currently available literature, the following recommendations have been formulated: i) the Ottawa Ankle/Foot Rule should be applied in order to rule out fractures; ii) physical examination is sufficient for diagnosing injuries to the lateral ligament complex; iii) classification into stable and unstable injuries is applicable and of clinical importance; iv) the squeeze-, crossed leg- and external rotation test are indicative for injuries of the syndesmosis; v) magnetic resonance imaging is recommended to verify injuries of the syndesmosis; vi) stable ankle sprains have a good prognosis while for unstable ankle sprains, conservative treatment is at least as effective as operative treatment without the related possible complications; vii) early functional treatment leads to the fastest recovery and the least rate of reinjury; viii) supervised rehabilitation reduces residual symptoms and re-injuries. Taken these recommendations into account, we present an applicable and evidence-based, step by step, decision pathway for the diagnosis and treatment of acute ankle injuries, which can be implemented in any emergency department or doctor’s practice. It provides quality assurance for the patient and promotes confidence in the attending physician

Calculation-and-experimental estimation of the role of the frequency ratio in changing the endurance at two-frequency deformation modes

2019 ◽  
Vol 85 (1(I)) ◽  
pp. 64-71 ◽  
Author(s):  
M. M. Gadenin
Keyword(s):  
High Frequency ◽  
Experimental Studies ◽  
Low Frequency ◽  
Reduction Factor ◽  
Single Frequency ◽  
Cyclic Loads ◽  
Small Ratio ◽  
Harmonic Components ◽  
Deformation Modes

The cycle configuration at two-frequency loading regimes depends on the number of parameters including the absolute values of the frequencies and amplitudes of the low-frequency and high-frequency loads added during this mode, the ratio of their frequencies and amplitudes, as well as the phase shift between these harmonic components, the latter having a significant effect only with a small ratio of frequencies. Presence of such two-frequency regimes or service loading conditions for parts of machines and structures schematized by them can significantly reduce their endurance. Using the results of experimental studies of changes in the endurance of a two-frequency loading of specimens of cyclically stable, cyclically softened and cyclically hardened steels under rigid conditions we have shown that decrease in the endurance under the aforementioned conditions depends on the ratio of frequencies and amplitudes of operation low-frequency low-cycle and high-frequency vibration stresses, and, moreover, the higher the level of the ratios of amplitudes and frequencies of those stacked harmonic processes of loading the greater the effect. It is shown that estimation of such a decrease in the endurance compared to a single frequency loading equal in the total stress (strains) amplitudes can be carried out using an exponential expression coupling those endurances through a parameter (reduction factor) containing the ratio of frequencies and amplitudes of operation cyclic loads and characteristic of the material. The reduction is illustrated by a set of calculation-experimental curves on the corresponding diagrams for each of the considered types of materials and compared with the experimental data.

scholarly journals Evaluating and Differentiating Ankle Instability

2019 ◽  
Vol 54 (6) ◽  
pp. 617-627 ◽  
Author(s):  
Phillip A. Gribble
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
High Rate ◽  
Diagnostic Tools ◽  
Ankle Sprains ◽  
Lateral Ankle ◽  
The Status ◽  
History Of ◽  
Ankle Complex

Given the prevalence of lateral ankle sprains during physical activity and the high rate of reinjury and chronic ankle instability, clinicians should be cognizant of the need to expand the evaluation of ankle instability beyond the acute time point. Physical assessments of the injured ankle should be similar, regardless of whether this is the initial lateral ankle sprain or the patient has experienced multiple sprains. To this point, a thorough injury history of the affected ankle provides important information during the clinical examination. The physical examination should assess the talocrural and subtalar joints, and clinicians should be aware of efficacious diagnostic tools that provide information about the status of injured structures. As patients progress into the subacute and return-to-activity phases after injury, comprehensive assessments of lateral ankle-complex instability will identify any disease and patient-oriented outcome deficits that resemble chronic ankle instability, which should be addressed with appropriate interventions to minimize the risk of developing long-term, recurrent ankle instability.

scholarly journals Role of magnetic resonance imaging in ankle sprains

2021 ◽  
Vol 25 (1) ◽  
pp. 438-445
Author(s):  
Nawroz Othman ◽  
Salwa AL-Najjar
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Evaluation ◽  
Ankle Sprain ◽  
Soft Tissues ◽  
Ankle Injuries ◽  
Bone Lesions ◽  
Ankle Sprains ◽  
Resonance Imaging ◽  
Imaging Results

Background and objective: Musculoskeletal injuries frequently occur in the ankle in both the athletic and general population. Ankle sprains are among the most frequent types of ankle injuries, which are conventionally diagnosed through clinical examinations. However, magnetic resonance imaging can provide a more precise diagnosis, leading to better injury management and prevention of consequent chronic complications. The present study aimed to examine the significance of magnetic resonance imaging in detecting and assessing changes that occur in ligaments and soft tissues in patients with ankle sprains. Methods: In a prospective study, 50 patients with ankle sprain referred to Rizgary and Erbil Teaching hospitals in Erbil city, Iraqi Kurdistan Region, from March 2018 to April 2019, were included in the study. They underwent clinical evaluation and MRI (GE general electric 1.5 Tesla). Two expert radiologists analyzed the magnetic resonance imaging images, and the results were compared. The collected data were analyzed using SPSS version 23 through descriptive statistics. Results: Most patients (64%) belonged to the age groups of 30-49 years old. Most of them (64%) were males. Most events of ankle sprain (66%) were because of sports and accidents. The clinical evaluation proved 82% of the ankle sprains. Regarding the laterality of the lesions, 60% were spotted in the right ankles and 40% in the left. According to magnetic resonance imaging results, both radiologists diagnosed that the ankle sprains included bone lesions, ligament injury, tendon injury, and effusion. There was an agreement of ≥ 96% between the two radiologists in this regard. The two radiologists were not significantly different in terms of diagnosing the ligament side. As reported by the radiologists based on the magnetic resonance imaging images, the anterior, lateral, and medial tendons were normal in most cases. Conclusion: Magnetic resonance imaging is a vitally important tool that can be utilized reliably and accurately to diagnose and evaluate changes in ligaments and soft tissues in patients with ankle sprains. Keywords: Magnetic resonance imaging (MRI); Ankle sprain; Ligaments; Injuries.

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